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HYDRO28854
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HYDRO28854
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Entry Properties
Last modified
8/24/2016 8:47:58 PM
Creation date
11/20/2007 9:57:11 PM
Metadata
Fields
Template:
DRMS Permit Index
Permit No
M1982036
IBM Index Class Name
Hydrology
Doc Date
2/6/1985
Doc Name
PERIODIC INSPECTION FORM WATER SEDIMENT OR SLURRY IMPOUNDMENTS
Media Type
D
Archive
No
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GENERAL INSTRUCTIONS <br />I. If form has been partially completed by preprinting, disregard instruction directed at entry of that information :drzaJv preprinleJ <br />?. Enter "PERMITTEE NAMF!M AILING ADDRESS land facility name/location, if Ji Rcrcmi." "PERMIT NUMBh K." and "DISCHARGE <br />NUMNER" where indicated !A separme form is required for each dixharge.) <br />3. Enter Jutes beginning and ending "MONITORING PERIOD" covered by form where indicated. <br />4. Enter each "PARAh1ETER" as specified in monitoring requirements of permit. <br />5. Enter "SAMPLE MEASUREMENT" data for each parameter under'QUANTITY" anJ "QUALITY" in units specified in permit <br />"AVERAGE" is normally a'ilhmetic average Igzomclnc average (or hactzrial parameiersl of all sample measurements for c.¢h parameter <br />obtained during "A10NITORING PERIOD." "M:\XIAfUDi" and "MINIAtUAt" are normally extrcmz high and low measurements <br />oMained during "MONITORING PERIOD.~~ tNOI F to municipals with secondary Treatment reyuirement. enter 314Jay average of sample <br />measuremenu under "AVERAGE" and enter maximum 7-day overage of sample measurements obtained during monitoring perioJ under <br />"hfAXIMUM". <br />6. Enter "PERMIT REQUIREMENT" for each parameter under "QUANTITY" and "QUAI ITl"' as specified in permit. <br />7. Under "NO. EX" enter number of sample measurements Juring monitoring period that exceed maximum (and/or minimum or 7-day <br />overage as appropriate) permit requirement (or each parameter. I( none, enter "0". <br />B. Enter "FREQUENCY OF AV ALYSIS" both as "SA AI PI_E MEASUREMENT" (actual frequency of sampling and analysis used Juring <br />monitoring period) and as "PERMIT REQUIREMENT" specified in permit. (e.g., Enter "CONT." (or continuous monitoring, <br />"I/7" (or ono day per weeA, "I/l0" for one day per month. "I /90" for one day per quarter, etc.) <br />9. Enter "SAMPLE TYPE" both as "SA h1PLE MEASUREMENT" (actual sample type used during monitoring perioJ) and as <br />"PERMIT REQUIREhENT." (e.g., Enter "GRAB" (or individual sample, "'_4HC" (or 2a-hour composite, "N/A" (or continuous <br />monitoring, e1cJ <br />l J.5tl1! 3tl3X OlOl) <br />I(I. WHERE VIOLATIONS OF PERAfIT REQUIREMENTS ARE REPORTED, ATTACH A BRIEF EXPLANATION TO DESCRIBE <br />CAUSE AND CORRECTIVE ACTIONS TAKEN. REFERENCE EACH VIOLATION BY DATE. <br />11. If "no discharge" occurs during monitoring period, enter "NO DISCH.4RG E" across form in place of data entry. <br />12. Enter "NAA1E~I'ITLE OF PRINCIPAL EXECUTIVE OFFICER" with "SIGNATURE OF PRINCIPAL EXECUTIVE OFFICER OR <br />AUTHORIZED AGENT," "TEI_E PHONE NUMBER" and "DATE" at bottom of form. <br />13. Mail signed Repot[ to Office(s) by date(s) specified in permit. Retain copy for }•our records. <br />14. More detailed instructions for use of this DISCHARGE MONITORING REPORT (DMR) form may be obtained from Officels) <br />specified in permit. <br />LEGAL NOTICE <br />This report is required by law (33 U.S.C. 1318: 40 C.F.R. 122.22). Failure to report or failure Io report truthfully can result in civil penalties not <br />to exceed 810,000 per day of violation; or in criminal penalties not to exceed 825,000 per day of violation, or by imprisonment for not more than <br />one year, or by both. <br /> <br />ON0035 3tl3N Ol0! <br />3a3H <br />dWV1S <br />37tl1d <br />OtlIHl 3tl3X OIOd <br />• 3a3H 3ldtl1S • <br />4--~ <br />' r ~ <br />
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